Painful degenerative joint disease of the ankle can be caused by many conditions including osteoarthritis, rheumatoid arthritis, trauma and deformity. These conditions are typically treated by surgical methods including fusion with screw fixation, fusion with intramedullary nailing, or a total ankle arthroplasty. Each of these choices presents significant problems. For instance, a screw used in fusion screw fixation may loosen over time and result in loss of fixation. Fusion screw fixation also involves a risk of screw migration or breakage, and may necessitate prolonged post-operative non-weight-bearing limitations on the patient. Traditional intramedullary nailing options may provide a stronger construct than fusion screw fixation and permit earlier post-operative weight-bearing activities by the patient. However, traditional intramedullary nails span the subtalar (talocalcaneal) joint and thus destroy the subtalar (talocalcaneal) joint. This aspect of traditional intramedullary nails severely limits motion of the hindfoot and makes it difficult to walk, especially on uneven surfaces. Another problem with traditional intramedullary nails is that such nails transfer a significant amount of stress to other joints of the foot, which can lead to degeneration of these joints, additional pain, and in some cases, require further surgical intervention. Because total ankle arthroplasty typically has an unacceptably high failure rate, ankle fusion is generally viewed as a more reliable choice for the treatment of degenerative joint disease of the ankle.
Currently available intramedullary nailing options, while better than most other treatment options, each require the fusion nail to be inserted through the heel bone or calcaneus bone, through the subtalar (talocalcaneal) joint, up through the talus bone, through the tibiotalar joint, and into the tibia. A need therefore exists for devices and methods for delivering a secured fusion nail that bypasses and preserves the subtalar (talocalcaneal) joint.